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Total calcium intake and colorectal adenoma in young women

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Abstract

Background

Total calcium intake appears to reduce occurrence of colorectal adenoma; however, the dose necessary for prevention in young women is unclear. We examined fine categories of calcium intake in relation to occurrence of first colorectal adenoma in a cohort of mostly premenopausal (88 %) women aged 26–60 at time of endoscopy.

Design

We conducted an analysis among 41,403 participants in the Nurses’ Health Study II and assessed intakes of calcium prior to endoscopy through participants’ responses to biannual questionnaires.

Results

Between 1991 and 2007, we documented 2,273 colorectal adenoma cases. There was a significant trend across categories of calcium intakes with lowest intakes suggestive of higher occurrence of adenoma (p = 0.03) and those in the distal colon (p = 0.03) and rectum (p = 0.04). Compared with 1,001–1,250 mg/day of calcium intake, ≤500 mg/day was suggestive of a modest increase in occurrence of adenoma (multivariable RR = 1.21, 95 % CI 0.90–1.61); there were also suggestions of an increased risk with >500 to ≤700 mg/day of calcium. The association between ≤500 mg/day of calcium intake and adenoma was stronger for multiple (RR = 2.27, 95 % CI 1.38, 3.72), large (≥1 cm) (RR = 2.01, 95 % CI 1.27, 3.21), and high-risk adenoma (≥1 cm or mention of villous histology/high-grade dysplasia) (RR = 1.76, 95 % CI 1.13, 2.72). No differences in associations were noted between jointly categorized calcium and phosphorus or magnesium intakes.

Conclusions

Our findings suggest that low intakes of calcium, <500 and possibly 500–700 mg/day, in younger women are associated with an increased risk of multiple and advanced colorectal adenoma.

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Acknowledgments

We would like to thank the participants and staff of the Nurses’ Health Study II for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. In addition, this study was approved by the Connecticut Department of Public Health (DPH) Human Investigations Committee. Certain data used in this publication were obtained from the DPH. The authors assume full responsibility for analyses and interpretation of these data. This work was supported by research grant R01 CA55075/CA136950, R02 CA125837/CA 151993 from the National Institutes of Health. Our paper is the first to examine a dose–response relationship between calcium intake and risk colorectal adenoma in a group of largely premenopausal women who have estrogen to assist in calcium absorption. Knowing the lowest dose of calcium required to reduce risk of the precursors to colorectal cancer is important because higher intakes of dairy increases may increase risk of other unhealthy outcomes. Calcium intake is easily modifiable and can have an important public health message.

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Authors and Affiliations

  1. Departments of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA

    Jennifer Massa, Walter C. Willett, Kana Wu & Edward L. Giovannucci

  2. Departments of Biostatisics, Harvard School of Public Health, Boston, MA, USA

    Endel J. Orav

  3. Departments of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Walter C. Willett & Edward L. Giovannucci

  4. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Eunyoung Cho, Walter C. Willett & Edward L. Giovannucci

  5. Division of General Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Endel J. Orav

  6. Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, USA

    Eunyoung Cho

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  1. Jennifer Massa
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  2. Eunyoung Cho
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  6. Edward L. Giovannucci
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Corresponding author

Correspondence to Jennifer Massa.

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Kana Wu and Edward L. Giovannucci are co-senior authors.

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Massa, J., Cho, E., Orav, E.J. et al. Total calcium intake and colorectal adenoma in young women. Cancer Causes Control 25, 451–460 (2014). https://doi.org/10.1007/s10552-014-0347-9

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